Human resource implications of expanding latent tuberculosis patient care activities

Hannah Alsdurf; Andrea Benedetti; Tran Ngoc Buu; Menonli Adjobimey; Victoria J Cook; Dina Fisher; Gregory Fox; Federica Fregonese; Panji Hadisoemarto; James Johnston; Richard Long; Joseph Obeng; Olivia Oxlade; Rovina Ruslami; Kevin Schwartzman; Erin Strumpf; Dick Menzies

doi:10.3389/fmed.2023.1265476

Human resource implications of expanding latent tuberculosis patient care activities

Front Med (Lausanne). 2024 Jan 12:10:1265476. doi: 10.3389/fmed.2023.1265476. eCollection 2023.

Authors

Hannah Alsdurf^{1

2}, Andrea Benedetti^{1

2}, Tran Ngoc Buu³, Menonli Adjobimey⁴, Victoria J Cook^{5

6}, Dina Fisher⁷, Gregory Fox⁸, Federica Fregonese², Panji Hadisoemarto⁹, James Johnston⁵, Richard Long¹⁰, Joseph Obeng¹¹, Olivia Oxlade^{2

12}, Rovina Ruslami¹³, Kevin Schwartzman^{1

2

12}, Erin Strumpf¹, Dick Menzies^{1

2

12}

Affiliations

¹ Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
² McGill International TB Centre, McGill University, Montreal, QC, Canada.
³ Woolcock Institute of Medical Research, Hanoi, Vietnam.
⁴ Programme National Contre la Tuberculose, Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin.
⁵ Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada.
⁶ Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁷ Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada.
⁸ The University of Sydney Central Clinical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
⁹ Department of Public Health, Faculty of Medicine, TB-HIV Research Center, Universitas Padjadjaran, Bandung, Indonesia.
¹⁰ Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
¹¹ Chest Clinic, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
¹² Respiratory Epidemiology and Clinical Research Unit (RECRU), McGill University, Montreal, QC, Canada.
¹³ Department of Biomedical Sciences, Division of Pharmacology and Therapy, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.

Abstract

Introduction: The World Health Organization (WHO) declared increasing services for latent tuberculosis infection (LTBI) a priority to eliminate tuberculosis (TB) by 2035. Yet, there is little information about thehuman resource needs required to implement LTBI treatment scale-up. Our study aimed to estimate the change in healthcare workers (HCW) time spent on different patient care activities, following an intervention to strengthen LTBI services.

Methods: We conducted a time and motion (TAM) study, observing HCW throughout a typical workday before and after the intervention (Evaluation and Strengthening phases, respectively) at 24 health facilities in five countries. The precise time spent on pre-specified categories of work activities was recorded. Time spent on direct patient care was subcategorized as relating to one of three conditions: LTBI, active or suspected TB, and non-TB (i.e., patients with any other medical condition). A linear mixed model (LMM) was fit to estimate the change in HCW time following the intervention.

Results: A total of 140 and 143 HCW participated in the TAMs during the Evaluation and Strengthening phases, respectively. Results from intervention facilities showed an increase of 9% (95% CI: 3%, 15%) in the proportion of HCW time spent on LTBI-related services, but with a corresponding change of -11% (95% CI: -21%, -1%) on active TB services. There was no change in the proportion of time spent on LTBI care in control facilities; this remained low in both phases of the study.

Discussion: Our findings suggest that additional HCW personnel will be required for expansion of LTBI services to ensure that this expansion does not reduce the time available for care of active TB patients.

Keywords: active tuberculosis (TB); health system strengthening; latent tubercolosis infection; time and motion studies; tuberculosis - epidemiology.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the Canadian Institutes of Health Research (grant FDN-143350). This funding agency had no role in study design, interpretation or writing of this report.